Oxidative stress (OS) has become the most discussed topic, especially in the last two decades due to its association with multiple pathological conditions. Since the discovery of its existence, several biomarkers and anti-oxidants have been identified, yet its association with diseases has not been successfully delineated despite management of the diseases. Experimental hypothyroidism when coupled with other free radical-generating conditions and also being a hypo-metabolic state, attenuates OS up to an extent. Nevertheless, hypothyroidism per se has been associated with OS despite several studies refuting its presence. Therefore, OS in hypothyroidism is a controversial topic of worth analysis.

Background and Aim: The undergraduate and postgraduate medical students withstand persistent pressure during their studies. This cross-sectional study is designed with the aim to find out the incidence of stress among undergraduate medical students of different academic years, and explore the effect of gender and difference in ethnicity, cultural, and social background on perceived stress and their coping strategies.
Methods: We used a questionnaire to assess the level of perceived stress among Saudi and Pakistani undergraduate students in medical schools.
Results: Around 46% Umm al Qura undergraduate medical students were found to be stressed with average stress score ranging between 15 and 15.43. On the other hand, Karachi Medical and Dental College students showed increased incidence of stress (63%), but their average scores are more or less similar to that of Saudi students. Academic overload is the major stressor and cognitive, emotional, and behavioral issues are common in both medical schools. Prayers and socializing with friends are the main coping strategies observed at both places.
Conclusion: Difference in ethnicity, cultural, and social background affects the incidence of stress but not the severity. Measures should be taken to reduce the academic stress. Developing a supportive environment, providing student counseling, and educating them about time management may play an important role in reducing the incidence of stress as well as its severity.

A new method for pain management in total knee arthroplasty: Intraoperative local anesthetic application in addition to one-shot femoral block

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Aykut SigirciDOI:10.4103/2348-8093.180016

Background and Aim: Total knee arthroplasty (TKA) is an effective treatment for end-stage knee arthritis, but the optimal management of postoperative pain remains controversial. Therefore, this study investigated the efficacy of different local anesthetic application methods on early, 1 st day pain control after TKA.
Methods: A total of 200 patients who underwent unilateral TKA surgery with spinal anesthesia were randomly assigned into four different groups (50 in each) and were administered pain control by different peri-and post-operative regimens. Group A was the control group wherein no postsurgical analgesia was administered to assess spinal anesthesia efficacy; in Group B, only postsurgical one-shot femoral block was applied; in Group C, intraoperative periarticular local anesthetic was applied; in Group D, a combination of the one-shot femoral block and intraoperative periarticular local anesthetics were applied.
Results: Group D patients experienced significantly better postoperative pain relief (P < 0.05) and were therefore more relaxed in pain and knee flexion than the other patient groups.
Conclusion: The intraoperative periarticular application of local anesthetics in addition to one-shot femoral block is an efficient way of controlling postsurgical pain after TKA.

Background and Aim: The circadian rhythm is known to influence a number of physiological and pathological cardiovascular processes including the incidence of acute myocardial infarction. Therefore, in the present work the role of gender in anterior wall ST-Segment Elevated Myocardial Infarction (STEMI) patients have been studied.
Methods: In this hospital-based, cross-sectional study, 200 patients were chosen as per the selection criteria from among the acute myocardial infraction (MI) patients admitted in the Department of Cardiology, Medical College Hospital, Kottayam.
Results: Of the 200 subjects, 166 (83%) survived MI while 34 (17%) developed complications; statistical analytic tests applied between the time of onset of symptoms and the clinical outcome of the subjects were nonsignificant. A progressive increase was seen in the incidence of anterior wall myocardial infarction as age advances. There is a statistically significant higher occurrence of systemic hypertension in female subjects compared to the incidence of other comorbid illnesses among males and females.
Conclusion: Occurrence of STEMI shows the first peak between 6 AM and 12 Noon and the second peak was from 12 Noon to 6 PM. There is a statistically significant higher occurrence of systemic hypertension in female subjects compared to the incidence of other comorbid illnesses among males and females. There is no significant correlation between the time of onset of symptoms and complications in any particular gender. Mortality was higher in males and the deaths in each period were proportionate irrespective of the circadian pattern.

Background and Aim: Although hypothalamic and extrahypothalamic areas are known to influence food intake (FI), body weight (BW) and immunity, the exact nature and magnitude of alteration following lesion of these areas have not adequately studied. Therefore, the present study was aimed at comparing the effect of lesions of ventromedial hypothalamus (VMH) and posterodorsal amygdala (PDA) on FI, BW gain and immunological parameters in albino Wistar rats.
Methods: A total of 48 albino Wistar rats were taken for the study and were divided equally into VMH group and PDA group with 12 control and 12 experimental rats in each. Bilateral electrolytic lesion of the respective nuclei was performed by stereotaxy. The pre- and post-lesion parameters of both groups were compared.
Results: The percentage increase in FI and BW gain was significantly less (P < 0.001) in the experimental rats of PDA group. There was a significant difference in the percentage change in cluster of differentiation 4 (CD4) and CD8 concentration (P < 0.001) in experimental rats of PDA group compared with the experimental rats of VMH group. The percentage decrease in albumin and globulin (P < 0.001) levels and the percentage increase in albumin-globulin ratio (P < 0.001) was significantly less in experimental rats of PDA group.
Conclusion: The above-mentioned findings suggest that the role of VMH on feeding is more pronounced than PDA, indicating that VMH has a stronger regulation of adiposity than PDA. Though VMH and PDA are involved in the regulation of immune functions, VMH has a stronger control over immune functions than PDA. Hence, VMH has greater control over adiposity, feeding behavior, and immune functions than PDA.

Sympathovagal imbalance is enhanced by smoking in Saudi male young adults with prehypertension

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Tarek Mohamed Ali, Laila Shehata DorghamDOI:10.4103/2348-8093.180019

Background and Aim: Hypertension and smoking are among the most common universal risk factors for heart attack and stroke, involving the impairment of the autonomic nervous system. Therefore, in this study, we aim to investigate the contribution of smoking to sympathovagal imbalance (SVI) in prehypertension.
Methods: Hundred and twenty-two male subjects aged 19-30 years were classified into nonsmoker normotensive (n = 38), nonsmoker prehypertensive (n = 38), smoker normotensive (n = 30), and smoker prehypertensive (n = 16). SVI was assessed from low-frequency power to high-frequency power (LF-HF ratio) and correlated with number of cigarette smoked/day in all the groups by Pearson's correlation.
Results: LF-HF ratio, LF and LF in normalized units were significantly (P < 0.001) increased and total power, HF and HF in normalized units were significantly (P < 0.001) decreased in prehypertensive subjects in comparison to normotensive subjects and these changes were more prominent in prehypertensive smokers. LF-HF ratio was positively correlated to basal heart rate, blood pressure (BP) and number of cigarette smoked/day (P < 0.001) in prehypertensive smokers. Smoking was found to be an independent contributing factor to SVI (P < 0.001) among prehypertensives.
Conclusion: In prehypertensive smokers, SVI was linked to number of cigarette smoking. Stopping smoking would enable to achieve the sympathovagal balance and BP homeostasis in prehypertensives.

Background and Aim: Spinal cord compression as observed in cervical spondylosis patients may result in focal autonomic deficit affecting various organ systems. Hence, in the present study we aim to assess the level of sympathetic activity in patients with cervical spondylosis using cold pressor test.
Methods: Cold pressor test was recorded in two groups comprising of thirty patients with cervical spondylosis and thirty healthy age and sex matched controls. Basal blood pressure (BP) was recorded in all the subjects. The BP values immediately after removal of hand from cold water and then after 5 minutes were also observed. Rate pressure product (RPP), a marker cardiovascular risk was calculated.
Results: The patients with cervical spondylosis during the recovery period showed a sustained rise in BP and RPP. A rise of more than 20/10 mm of Hg, or a failure of BP to return to basal levels after 5 minutes has a positive predictive value.
Conclusion: The patients with cervical spondylosis have higher sympathetic tone due to cervical compression.

Although cardiovascular (CV) risks are reported in the first-degree relatives (FDRs) of type 2 diabetics, the role of yoga therapy on these CV risks is not known. We investigated the effects of 12 weeks structured yoga therapy on rate pressure product (RPP), the marker of CV risk, in these high-risk subjects. FDRs of type 2 diabetics (n = 49) were trained and allowed to practice 12 weeks of structured yoga program. Body mass index (BMI), heart rate (HR), blood pressure (BP), and RPP were measured, and all these parameters were recorded and compared between pre- and post-yoga therapy periods. Bivariate logistic regression was performed to assess the contribution of BMI to change in RPP in these subjects. There was significant reduction in BMI (P = 0.0002), HR, BP, and RPP (P < 0.001) in these subjects. Bivariate logistic regression demonstrated independent more significant contribution of BMI to RPP in postyoga therapy period as compared to preyoga therapy period. It was concluded that FDRs of type 2 diabetics have high RPP and BP that decrease significantly following 12 weeks practice of yoga.